Acceptance and commitment therapy

In June 2011, City Lit will be running its second course based on this new approach to stammering therapy. City Lit speech and language therapists and students talk about the 3-day workshop.

What is ACT?

By Carolyn Cheasman, speech and language therapist

I first encountered Acceptance and commitment therapy (known as ACT) whilst studying for an MA in teaching mindfulness. There is a large body of evidence to support its effectiveness and it is increasingly used in clinical psychology when working with people with a range of psychological difficulties.

The two major goals of ACT are acceptance of experience which is out of personal control and taking committed action towards living a valued life. Harris (2007) sums this up as 'embrace your demons and follow your heart'! The view is that struggling to get rid of 'symptoms' can exacerbate difficulty and in ACT there is emphasis on reducing avoidance based coping strategies. However whilst there is not direct work on 'symptom reduction', change in the presenting difficulty frequently happens as a by-product.

There are six core processes in ACT making up the 'hexaflex'. These are:

Contact with the present moment - awareness of internal and external events in the here-and-now.

Defusion - looking at thoughts rather than being trapped in them. The aim of defusion is not to get rid of unwanted thoughts but to see thoughts for what they are, i.e. just thoughts, and not buy into them.

Self-as-context - developing a transcendent sense of self from which to notice and open to all experience.

Values - identifying the sort of person you really want to be and the things you want to do - what you want to stand for in life.

Committed action - taking action in the service of your valued directions.

Mindfulness skills are taught to develop the first four of these processes. ACT then places greater emphasis on taking action and goal setting than in other mindfulness based interventions.

To sum up, the aim in ACT is to make choices to move forward in your life in the directions you truly value with your difficulty whether this be anxiety, pain or stammering.

Thoughts about applying ACT to stammering

By Rachel Everard, speech and language therapist

It was thanks to Carolyn that I was introduced to ACT via the highly accessible and absorbing self-help book by Russ Harris 'The Happiness Trap'. The principles of ACT are highly relevant to stammering therapy in numerous ways and here are some examples:

The premise of the happiness trap: ACT teaches that our attempts to control a problem often only make it worse and what we do to overcome a problem may actually serve to maintain it. This is often the case in terms of stammering whether it be through struggle behaviour to get through a word or avoidance strategies which might result in less stammering in the short-term but at a cost in the long-term.

Self-acceptance: an alternative to struggling with stammering is to develop more acceptance of it and whilst people who stammer understand the importance of this it can be a huge challenge. One of the strengths of ACT is its use of metaphors and these can be immensely helpful to aid understanding of the importance of being with stammering rather than fighting against it. An example of a metaphor in this context is of someone stuck in quicksand: their automatic reaction is to struggle which only decreases their likelihood of survival. However if they can remain calm, lie back, stretch out and float, they stand a much greater chance of getting out alive.

Values/valued directions: once clients start to identify what's important to them in a broader sense, working on goals such as avoidance reduction can become much more motivating. For example, someone who stammers might have the value to be an effective manager which will involve attending meetings and speaking up at times for their department. They will be motivated to speak up in this type of situation as it will be in the service of this important value as well as helping them to become more desensitised to stammering.

Metaphors can be immensely helpful to aid understanding of the importance of being with stammering rather than fighting against it

Students' experiences

Last year City Lit ran a 3-day workshop on ACT for people who stammer, and two people who attended the course now share their experiences.

St John Harris

Acceptance and Commitment Therapy (ACT) seemed a natural progression for me of a philosophy I had already encountered at The City Lit on many different stammering courses: (i) that much of the problem lies beneath the surface of the iceberg; (ii) the inner stammer manifests itself through a whole range of avoidance behaviours which are maintained at enormous physical and emotional cost to the individual; (iii) a mass of negative feelings and fears about stammering can also be found beneath the surface; (iv) therapy is an attempt to understand, tackle, even question all this negative emotional baggage in order to reduce its grip on the person who stammers.

What ACT brings is (i) a powerful set of mindfulness skills to allow me to manage my painful thoughts and feelings more effectively, so that they have less impact on my life, and (ii) an opportunity to identify my values - what I want to be in life, what I want to do, and how I want to do it - in the different spheres of work/education, personal growth/health, relationships and leisure, in order to set myself goals which are consistent with these values.

Both aspects of the course complement each other. By cultivating contact with the present moment and learning to observe thoughts and feelings without engaging with them, I can also learn to accept and make space for them, without all the struggle and anxiety. With a clearer and calmer mind, I can instead devote my energies to creating a better life.

One value I rediscovered through ACT was the importance of my long standing and long distance friendships, some of which I had neglected over time. Realising the value of these friendships and what efforts I should make to breathe new life into them (for example, a letter, a telephone call, even a visit) was a rewarding outcome of the course for me.

What impressed me in particular about the course was its practical nature. Two techniques have proved especially useful for me: (i) taking ten slow, deep breaths, observing thoughts, and then expanding my awareness to my five senses; and (ii) building on this technique, to then observe sensations, breathe into them, create space for them and allow them. Simple, powerful techniques, but not easy.

ACT is not just for people who stammer, but has a broad application to all who suffer from self-limiting beliefs, anxiety or low self-esteem. The key message of transcending the struggle does however seem to have a peculiar resonance for people who stammer and could not be more topical - as evidenced by Colin Firth's portrayal of King George VI in The King's Speech.

Darren Attwood

Who wouldn't want to attend a course that could improve their life and possibly empower them to achieve more?

I am a covert stammerer, less so now but still some of the ingrained avoidance behaviours and lack of acceptance remain. The ACT course was of particular interest to me, a course that would help me work with my thoughts and feelings, and hopefully fling my 'doors of acceptance' open and loosen fear's grip on me!

The course encompassed many topics, from 'Defusion' techniques - as the name implies, trying to defuse/separate from your negative and unhelpful thoughts, to 'Acceptance' techniques - turning off the 'Struggle-switch' and accepting your feelings/ emotions. There was also 'Mindful Meditation', a simple but effective way to centre yourself and detach from the constant onslaught of thoughts. Then 'Goal setting' was thrown into the ring to complement the other therapies, something to encourage us to move towards positive goals.

The course content was superb with the therapists explaining concepts and giving accompanying handouts for each segment, detailing the key points/ideas with examples. There were plenty of exercises to do, both there and at home. I think a willingness to throw yourself into these courses only yields greater results, while the class discussions allowed people to bounce ideas off each other.

The course aligns itself well with the other speech therapies I have experienced, both at City Lit and elsewhere. It was useful gaining insight and understanding into my thought processes and seeing how these in turn can affect my feelings and ultimately behaviour. These techniques are powerful tools and with practice I hope will form the basis of me 'steadying my ship'.

All too often I have bemoaned my 'stammering curse' and this has led to my understandably negative views towards it. However, time and painful memories have taught me that with a little knowledge, hard work and some acceptance, I can perhaps retrain some of my long held beliefs.